A nurse is caring for a client who experienced a lacerated spleen and has been on bedrest for several days. The nurse auscultates decreased breath sounds in the lower lobes of both lungs. The nurse should realize that this finding is most likely an indication of which of the following conditions?

Delayed gastric emptying

Pulmonary edema

An upper respiratory infection

Atelectasis

Answer and Explanation

The Correct Answer is D

A. Delayed gastric emptying is not associated with decreased breath sounds in the lower lobes of the lungs. It is more commonly associated with gastrointestinal symptoms such as bloating and nausea.
B. While pulmonary edema can cause respiratory symptoms, such as crackles and wheezes, decreased breath sounds in the lower lobes are not typically indicative of pulmonary edema. Pulmonary edema is more commonly associated with fluid accumulation in the lungs, leading to crackles and other signs of fluid overload.
C. An upper respiratory infection primarily affects the upper airways, such as the nose and throat, and typically presents with symptoms such as nasal congestion, sore throat, and cough. It is not typically associated with decreased breath sounds in the lower lobes of the lungs.
D. Atelectasis refers to the collapse or closure of a part of the lung, leading to decreased air entry and breath sounds in the affected area. In a client who has been on bedrest for several days, atelectasis can occur due to reduced lung expansion and ventilation. Decreased breath sounds in the lower lobes are a common finding in atelectasis, especially when the condition affects the bases of the lungs, as gravitational forces can exacerbate the collapse of lung tissue in dependent areas. Therefore, this finding is most consistent with atelectasis.

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Correct Answer is C

Explanation

A. This statement reflects guilt or concern over potential harm to the child, which may be distressing but does not specifically indicate symptoms of PTSD related to combat exposure.
B. This statement describes nightmares or intrusive thoughts related to traumatic events, which are common symptoms of PTSD. The content of the dreams suggests re-experiencing of traumatic events, which is characteristic of PTSD.
C. This statement reflects hypervigilance and paranoia, common symptoms of PTSD. The client's behavior of checking rooms for potential threats indicates a heightened state of arousal and persistent fear related to past combat experiences.
D. While involvement in combat and actions such as killing enemy soldiers may contribute to the development of PTSD, this statement does not directly reflect symptoms of the disorder. Instead, it describes a specific event from the client's military experience. Symptoms of PTSD typically involve re-experiencing, avoidance, negative changes in mood and cognition, and hyperarousal.

A. "Crushing the medication might cause you to have a stomachache or indigestion B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you. C. Crushing is unsafe, as it destroys the ingredients in the medication. D. "Crushing the medication would release all the medication at once, rather than over time.

Correct Answer is D

Explanation

A. "Crushing the medication might cause you to have a stomachache or indigestion."
This response provides a potential adverse effect of crushing the medication but does not directly address the reason why the aspirin should not be crushed.
B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you."
This response suggests a solution to the client's difficulty swallowing medication but does not address the safety or efficacy concerns associated with crushing enteric-coated aspirin.
C. "Crushing is unsafe, as it destroys the ingredients in the medication."
While crushing enteric-coated aspirin may alter its release properties, it does not necessarily "destroy" the ingredients. This statement may be too absolute and not entirely accurate.
D. "Crushing the medication would release all the medication at once, rather than over time."
This response accurately explains why enteric-coated aspirin should not be crushed. Enteric coating is designed to prevent dissolution of the medication in the stomach and instead release it in the small intestine to reduce the risk of gastric irritation or ulceration. Crushing the medication would bypass this delayed release mechanism, potentially leading to increased gastric irritation or adverse effects.

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A nurse is caring for a client who experienced a lacerated spleen and has been on bedrest for several days. The nurse auscultates decreased breath sounds in the lower lobes of both lungs. The nurse should realize that this finding is most likely an indication of which of the following conditions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who was involved in heavy combat and observed war casualties. The nurse should suspect that the client is suffering from posttraumatic stress disorder (PTSD) if the client makes which of the following statements?

Correct Answer is C

Explanation

A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?

Correct Answer is D

Explanation

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